THE NEW YORKER, NOVEMBER 23, 2015 51
recovery, for Krakauer, would mean
that a patient was able to move her pa-
retic arm as she did before the stroke.
"We knew that spontaneous biolog-
ical recovery happens early," Krakauer
told me. "What could one do to max-
imally take advantage of this unique
period?" Everyone seems to agree that
something special is happening in the
brain during the first three months fol-
lowing a stroke; this is when most pa-
tients make their greatest gains. Nick
Ward, the stroke specialist, told me,
"John is certainly responsible for bring-
ing this new agenda into focus, this
question: What is it about this early
phase which is really important---is
this where to target our therapies?"
However, not all the doctors and
therapists I spoke with think that be-
ginning intensive movement therapy
in the early weeks following a stroke
is advisable, or even plausible. Carmi-
chael suggested that it would be di -
cult to get stroke patients to stick to
such a demanding regimen. He said,
"You take a seventy-five-year-old who
wasn't very active, and you're asking
him to be more active than he was be-
fore the stroke."
Krakauer agrees that what he's pro-
posing will require immense e ort on
the part of patients, as well as a restruc-
turing of the entire delivery system for
stroke rehabilitation. But a 2009 study
that translated animal doses of ther-
apy into human proportions provides
hope that people can complete such a
regimen. And Krakauer has a substan-
tial ally in his quest to rehabilitate the
arm: an "antigravity" robot.
The Hocoma ArmeoPower is a ro-
botic arm that brings to mind the love
child of a large dental chair and the
Nintendo Power Glove. The patient's
arm is strapped into a motorized ro-
botic sling, which can assist with move-
ments or, in the first few days after a
stroke, when patients might not be able
to move their arms independently, even
take over.
Rehabilitative video games can be
used in conjunction with the Hocoma;
some come preloaded. But most of
them are focussed on functional, real-
world tasks.The objective of one game
developed for use with the robot is
"grating carrots." "Abysmal games,"
Adrian Haith, a neuroscientist and
BLAM!'s co-director, said, laughing.
"The cleaning-the-stovetop game, the
picking-the-apples-in-the-supermarket
game."
For Krakauer, the game had to be
fun, and it had to be beautiful. Moti-
vation and reward, he said, play a huge
role in how we learn movement. "It's
not su cient to say, 'Take this, it's a
medicine,' " Krakauer said. "Physical
therapy is boring and di cult and un-
comfortable, and I planned to ask my
patients to spend two hours a day work-
ing hard in this virtual world." And
why should we expect a poorly de-
signed game to be an e ective ther-
apy? "It's like saying to somebody,
'When you are sick, you have to settle
for black-and-white TV.' "
Krakauer needed a paradox, a "non-
task-based task." He wanted to encour-
age "childlike exploration" with the arm,
in the workspace of daily life---the space
around the torso, where we make most
of our arm movements. Something anal-
ogous to what babies do when they're
learning how to speak. If conventional
therapy was like repeating a single con-
jugated sentence, Krakauer wanted his
patients to "babble," trying out count-
less varieties of movement.
Since 2008, Omar Ahmad had been
visiting the dolphins at the Na-
tional Aquarium, in Baltimore. He often
brought his son. The dolphins swam
upside down, shovelling bubbles at
Omar's face with the muscular petals
of their flukes. "I knew I was going to
make a dolphin simulation," Ahmad
said. "I was fascinated by their loco-
motion." Ahmad, who grew up in Eu-
gene, Oregon, did his Ph.D. at Johns
Hopkins. Part of his graduate work in-
volved making mathematical models
to predict hip fractures. "For hours, I
watched people walk," he said. "I got
really good at studying human loco-
motion." A former instructor of his in-
troduced him to Krakauer, who was
looking for a game designer. Although
Krakauer wasn't thinking dolphins quite
yet, he had a vision of "something tum-
bling through indigo."
Krakauer recalls taking a trip, in
2011, with Ahmad and Promit Roy,
whom Ahmad met when they were
both students at Johns Hopkins. "We
went to San Francisco together, to
the first Neuroscience and Gaming
Meeting---that was our honeymoon,"
Krakauer said. "And we just sat there
in contempt of it. We thought the games
were lame."
Krakauer's requirements for his
stroke game meshed with Ahmad and
Roy's goals for a commercial game, and
with their philosophy of design. Since
2008, Ahmad had been working on
games that included animal locomo-
tion; one of them, Aves, had been fea-
tured in the Apple store and earned
him a fan letter from Steve Jobs. Now
he wanted to make a "physics-based"
game, with highly realistic movement.
Roy recalls, "We thought that the way
things moved in games was all wrong;
we thought we could make it better."
They joined BLAM!, and a few months
later brought on board Kat McNally,
a twenty-five-year-old graphic artist
and a graduate of the Maryland Insti-
tute College of Art, whose vibrant
drawings and comics they admired.
They form a subgroup called the Kata
Project. (In Japanese, kata means "form." )
Though they're full-time employees of
the Johns Hopkins medical school, the
three also own an indie gaming com-
pany called Max and Haley.
One day, a sta er at the National
Aquarium noticed that Ahmad was
glued to the dolphin tanks; she sug-
gested that he read Diana Reiss's book
"The Dolphin in the Mirror." Reiss is
a leading dolphin researcher at Hunter
College and an advocate for the pro-
tection of dolphins. A friend of Krakau-
er's, she introduced the team to her close
friend, Sue Hunter, the head of animal
programs at the National Aquarium.
Together, the group worked on the
dolphin---"No, no," Hunter would
tell McNally, "the eyes lack a certain
spark." Or, "Yes, that dive posture looks
right." Last September, Hunter died of
a brain tumor. Before her final surgery,